This review synthesizes the latest understanding of key pathways of fecal microbes, in particular, enteric pathogens and soil-transmitted helminths (STHs), ingestion by Infants and young children (IYC), and the link to diarrhea, environmental enteric dysfunction (EED), and poor nutrition and development outcomes. The review is based on a thorough search of the scientific and gray literature on WASH, child undernutrition, and health, including snowball sampling (chain sampling) from citations within articles. The electronic searches and review of the literature were complemented by key informant interviews with researchers and field implementers to examine sources and pathways of fecal microbe transmission as well as the interventions to disrupt them.

This report seeks to:
• Consider both human and animal sources of fecal contamination and the pathways presenting major exposure risks to IYC, including sources and pathways previously underemphasized (and to the extent possible, seek to understand the relative potential importance of the different pathways in terms of magnitude of pathogen transmission);
• Examine the exposure pathways to which children in the first two years of life may be most susceptible to enteric pathogens and their potential importance; and
• Identify interventions to break these pathways, including established WASH measures and underemphasized risk factors such as animal husbandry, IYC feeding practices, and IYC-focused WASH behaviors.

Bibliographic information

USAID (2018). Toward a Hygienic Environment for Infants and Young Children: A Review of the Literature Washington, DC., USAID Water, Sanitation, and Hygiene Partnerships and Sustainability (WASHPaLS) Project.

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